You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you’ll have access to competitive benefits including a fresh perspective on workplace flexibility.
Clinical Account Manager (Specialty – Pharmacist)
Position Purpose: Provide clinical expertise to clients in designing benefits/clinical programs to optimize therapeutic outcomes while maintaining economic efficiency in the delivery of medication therapy. Interface with external clients and marketing staff to facilitate the development of clinical products that maximize cost effective medication benefits.
Provide expertise in benefit design planning methods and strategies
Provide clinical expertise to clients, explain clinical programs, and communicate new practice or clinical information to clients
Develop and present performance reviews in conjunction with client account team
Perform clinical data and drug utilization review analysis to meet client requirements and requests
Collaborate with Clinical Pharmacists to enhance drug utilization review program and prior authorization review process and assist with related activities
Provide input into the Request for Proposal process and work with Marketing and Sales to facilitate timely response and data analysis
Ensure that client clinical needs are met, including formulary management, benefit design, drug utilization review and clinical programs
Participate in the development and management of customized clinical business plans appropriate for each client, including the evaluation of current client program and restrictions (prior authorization, quantity limits, age limits) to determine appropriate utilization of drug therapy
Consult with clients to develop and implement appropriate clinical interventions and claim adjudication edits.
Participate in the development of disease state management modules by interfacing with company partners to improve array of marketable products
Performs other duties as assigned
Complies with all policies and standards
AcariaHeath Specialty Pharmacy:
Education/Experience: Bachelor’s degree and licensed qualification in pharmacy (PharmD., RPh). 3+ years of experience in Clinical pharmacy operations or case management experience in specialty pharmacy preferred. Direct experience interfacing with payers and/or manufacturers preferred.
License/Certification: Current state’s pharmacy license with no restrictions
Centene Pharmacy Services: 3+ years managed care pharmacy or pharmacy benefit management experience preferred
Job Specific Details
Clinical program management includes:
Upselling/consulting with clients on clinical programs and services
Oversee clinical reporting strategy for client portfolio, including proposing additional clinical programs and reporting that will deliver value to clients
Develop clinical strategic plan annually for client portfolio
Responding to RFPs for client-specific questions on renewals/re-procurement on clinical programs and services
Monitoring the pipeline for drugs in your client’s target disease states understand developments in therapy
Project Leadership across multiple clients or lines of business
Mentor non-Specialty CAMS to help drive value for their clients in Specialty Pharmacy Management
Collaborate with other members of the Account Team on resolving any clinical issues for your clients
Consider additional value add projects such as:
Precepting pharmacy intern or resident for an account management rotation
Revising, Suggesting or creating Clinical Policy and Procedures for Account Management team
Devise clinical programs for new and expanded Pharma contracts
Research patient requirements for pipeline and existing medications
Determine best in class solutions to exceed client goals
Draft requirements document outlining clinical program including ScriptMed technical requirements
Attend capabilities and finalist presentations for potential pharma clients.
May require:
Evaluating client data for opportunities
Identifying novel management opportunities
Preliminary design of visuals to address emerging specialty pharmacy management strategies
Some travel
Highly desired experience:
3+ years of experience with direct pharma or payer interaction
Clinical program development or case management experience in managed healthcare preferred.
Must be comfortable giving presentations in front of clients
Proficient in Microsoft Excel, Word, and PowerPoint.
Must be familiar with specialty pharmacy
Pay Range: $105,600.00 – $195,400.00 per year
Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual’s skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility.
Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act
